Form Scc759/921 - Application For A Certificate Of Authority To Transact Business In Virginia

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COMMONWEALTH OF VIRGINIA
Print Form
Clear Form
STATE CORPORATION COMMISSION
SCC759/921
APPLICATION FOR A CERTIFICATE OF AUTHORITY
(07/05)
TO TRANSACT BUSINESS IN VIRGINIA
Name of the corporation (include, if required, any "for use in Virginia" name in parentheses):
.
State or other jurisdiction of incorporation
.
Date of incorporation:
Period of duration:
(Mark if applicable:)
The corporation was previously authorized or registered with the Commission to transact business
in Virginia as a foreign business entity. (See instructions.)
Set forth the additional required information on an attachment.
The corporation's principal office address, including the street and number, if any, is
.
(number/street)
(city or town)
(state)
(zip)
The name of the VIRGINIA registered agent is
.
The registered agent is (mark appropriate box):
(2)
a domestic or foreign stock or nonstock
(1) an individual who is a resident of Virginia and
corporation, limited liability company or
an officer of the corporation.
OR
registered limited liability partnership
a director of the corporation.
a member of the Virginia State Bar.
authorized to transact business in Virginia.
The foreign corporation’s VIRGINIA registered office address, including the street and number, if any,
which is identical to the business office of the registered agent, is
________________________________________________________________, VA ______________,
(number/street)
(city or town)
(zip)
which is physically located in the
county or
city of
.
OFFICERS:
NAME AND TITLE
BUSINESS ADDRESS
_________________________________
______________________________________________
______________________________________________
_________________________________
______________________________________________
______________________________________________
DIRECTORS:
NAME
BUSINESS ADDRESS
_________________________________
______________________________________________
______________________________________________
_________________________________
______________________________________________
______________________________________________
STOCK: NUMBER OF SHARES AUTHORIZED TO BE ISSUED
CLASS AND SERIES
The undersigned executes this application in the name of the corporation and declares the facts stated herein to be true:
(signature)
(printed name)
(corporate title)
(date)
Telephone number (optional): ________________________________________
See important instructions on the reverse

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